NHS: CQC report: Trust Special Administrators not fit for purpose

The secretary of state, the medical director of NHS England and the Trust Special Administrator were dangerously wrong last year

Last year, Jeremy Hunt stood before parliament and declared that Queen Elizabeth Hospital’s A&E could save 100 extra lives a year if neighbouring Lewisham Hospital was run down. But last week a Care Quality Commission (CQC) report declared that Queen Elizabeth Hospital (QEH) A&E is ‘not fit for purpose’.

So what’s changed?

The CQC are responsible for assessing care, and in February a team of clinicians descended on Lewisham and Greenwich NHS Trust (which includes Queen Elizabeth Hospital) to evaluate safety and ‘encourage’ changes. They saw that the A&E couldn’t cope and they gave the reason why:

“We saw a shortage of beds for admission to the hospital. This created a block in the system particularly for patients from A&E… Additionally, bed occupancy in the trust is regularly over 85 per cent, which… indicates that there is insufficient capacity in the hospitals bed numbers…”

Everyone who uses the hospital has known about the bed shortage since neighbouring Queen Mary’s in Sidcup closed. It served a population larger than Hull or Brighton, 250,000 people, but when it closed, the minimum 80 beds that QEH needed to cope never opened.

Between July 2012 and March 2013, Matthew Kershaw ran QEH as the country’s first Trust Special Administrator. He insisted the solution to QEH’s problems was to cut £100 million from the healthcare budget while simultaneously closing maternity, emergency, children’s and intensive care services at Lewisham Hospital – at the time they were a different trust and also serve 250,000 people.

Kershaw had been appointed because QEH’s hospital trust was financially ‘failing’ – on account of an unmanageable, hyperbolic PFI debt. They spent £5 million trying to analyse the cause of the hospital’s failure, but they made no mention of bed occupancy in their hundreds of pages of reports, recommendations and appendices.

By trying to ‘balance the books’ at a hospital with an unaffordable PFI debt, Matthew Kershaw dreamed up changes that Jeremy Hunt almost turned into a humanitarian nightmare. A massive increase in workload at an A&E which is ‘unfit for purpose’, at the same time as making huge cuts, would have created an example of the law of diminishing returns expressed in death rates. The only thing that stopped them was a local campaign and the high court, which deemed the plans ‘unlawful’.

But despite this complete misjudgement, Jeremy Hunt has now increased the role of Trust Special Administrators by a back-door ‘hospital closure clause’ added to the Health and Social Care Act. He has also promoted Matthew Kershaw to chief executive of Brighton and Sussex University Hospital Trust; and Sir Bruce Keogh remains medical director of NHS England, despite the baseless misinformation he provided to Jeremy Hunt – which had already been flagged up by a group of Lewisham Hospital consultants and Freedom of Information requests.

The headlines about Queen Elizabeth Hospital A&E missed the bigger story. The secretary of state, the medical director of NHS England and the Trust Special Administrator were dangerously wrong last year. And they will never admit it, for two reasons.

Firstly, increasing the bed numbers is expensive – especially at a PFI-managed hospital that will extort the cost of any change to the building from the taxpayer.

Secondly, the health secretary has committed the cardinal sin described by the Francis Report. He put patients last. He preferred the expertise of an administrator motivated by finances to the opinion of local clinicians. The Francis Report, which the health secretary waves at nurses like a drunken headmaster with a cane, explicitly criticised a management culture that put corporate financial objectives first, but this is what the health secretary will impose wherever he appoints an administrator.

Had frontline medical or nursing staff made a misdiagnosis as dangerous as Hunt and Kershaw, we’d be sued, demonised by the media and, if it was really bad, by Jeremy Hunt himself- who likes to tell people how NHS nurses aren’t caring enough and are ‘coasting’. Yet the CQC has also shown up his underestimation of NHS staff, stating clearly that:

“The staff on both sites are committed to high quality care and this is a focus of their work.”

It’s unlikely the same could have been said of the health secretary when he recommended Lewisham Hospital be decimated so that an ‘unfit’ A&E could cater for 750,000 people.

The CQC should be applauded for their rigorous, clinical inspections at a time when the actions coming from the government work backwards from the premise of cutting costs. But it’ll be interesting to see how many more of their reports mention bed occupancy under the chairmanship of newly-appointed David Prior, the former Conservative MP and deputy chairman, who has said the NHS will ‘go bust’ if it doesn’t change.

Iain Wilson is a nurse and was secretary of the Save Lewisham Hospital campaign